Enalapril Aspirin

Aspirin 81 mg once daily Metoprolol 50 mg twice daily Enalapril 5 mg twice daily Furosemide 40 mg daily... 

Enalapril 1 0 mg twice daily Aspirin 325 mg once daily... 

Amprenavir, indinavir, nelfinavir, ritonavir, saquinavir Allopurinol Argatroban Aspirin Amoxicilhn Captopril, enalapril... 

A 72-year-old man with diabetes mellitus and cardiovascular disease developed major depression. He was taking aspirin (100 mg/day), enalapril (20 mg/day), and glibenclamide (5 mg/day). His serum sodium was 133 mmol/1 (reference range 134—146 mmol/1). He started to take reboxetine (4 mg/day) and after 8 days experienced malaise and nausea, at which time his serum sodium had fallen to 118 mmol/1. The reboxetine was withdrawn, and both his symptoms and the low serum sodium remitted over the next 6 days. Rechallenge with reboxetine produced a recurrence of both the low sodium and the accompanying symptoms. 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS ASPIRIN t risk of renal impairment. 1 efficacy of captopril and enalapril with high-dose (>100mg/day) aspirin Aspirin and NSAIDs can cause elevation of BP. Prostaglandin inhibition leads to sodium and water retention and poor renal function in those with impaired renal blood flow Monitor renal function every 3-6 months watch for poor response to ACE inhibitors when >100mg/day aspirin is given... 

Enalapril, paracetamol, sotalol, dipyrone, vancomycin, captopril, fluconazole, cefazolin, metoprolol, aspirin, ticlopidine, prednisolone, propranolol, digoxin, sildenafil, furosemide, dexamethasone, carvedilol, ketoprofen, nifedipine, terbinafine, acenocoumarol, spironolactone/urine HPLC DAD Column LiChroCART Purospher STAR, RP-18e (250 x 4 mm, 5 pm) Mobile phase MeOH ACN 0.05 % TFA in water (gradient elution) Detection DAD X = 200 50 nm Adjusted to pH 7.0, protein precipitation LOD 0.01-1.44 pg/mL LOQ 0.04-4.35 pg/mL [72]... 

From a post-hoc analysis of the SOLVD trial, it appears that in patients with left ventricular systolic dysfunction, the use of aspirin was associated with improved survival and reduced morbidity. In aspirin users, benefit from enalapril was retained but reduced (106). 

Spaulding C, Charbonnier B, Cohen-Solal A, Juilliere Y, Kromer EP, Benhamda K, Cador R, Weber S. Acute hemodynamic interaction of aspirin and ticlopidine with enalapril results of a double-blind, randomized comparative trial. Circulation 1998 98(8) 757-65. 

Katz SD, Radin M, Graves T, Hauck C, Block A, LeJemtel TH. Effect of aspirin and ifetroban on skeletal muscle blood flow in patients with congestive heart failnre treated with Enalapril. Ifetroban Study Group. J Am Coll Cardiol 1999 34(l) 170-6. 

Cocaine, esmolol, aspirin, enalapril, capecitabine, succinylcholine... 

Noninterfering amiloride, acebutolol, acenocoumarol, acetaminophen, aspirin, allopuri-nol, ambroxol, amoxicillin, atenolol, bendroflumethiazide, benzbromarone, bezafibrate, biperiden, bisacodyl, bromazepam, butizide, captopril, cimetidine, ciprofloxacin, clobu-tinol, clonidine, cotinine, diazepam, diclofenac, digitoxin, digoxin, dihydrocodeine, dihy-droergotamine, diltiazem, doxepin, doxycycline, enalapril, erythromycin, fenoterol, furosemide, glibenclamide, heparin, h3qjoxanthine, ibuprofen, indomethacin, isosorbide... 

Procaine, aspirin, clofibrate, meperidine, enalapril, cocaine... 

To meet the speed and high efficiencies in separations demanded by the pharmaceutical industry, combined HPLC methods have been frequently used to simultaneously determine combination products [67]. A stability-indicating method for the simultaneous determination of aspirin and warfarin in warfarin sodium/aspirin combination tablets has been recently developed and validated [68]. In another example [69], the simultaneous determination of enalapril (2) and its two degradants, enapril-DKP (3) and enalapril-diacid (4), and felodipine (5) and its degradant, named HI52/37 (6) was achieved using combined method approach. 

The antihypertensive efficacy of captopril and enalapril may be reduced by high-dose aspirin in about 50% of patients. Low-dose aspirin (less than or equal to 100 mg daily) appears to have little effect. It is unclear whether aspirin attenuates the benefits of ACE... 

Two groups of 26 patients, one with mild to moderate hypertension taking enalapril 20 mg twice daily and the other with severe primary hypertension taking enalapril 20 mg twice daily (with nifedipine 30 mg and atenolol 50 mg daily), were given test doses of aspirin 100 and 300 mg daily for 5 days. The 100-mg dose of aspirin did not alter the efficacy of the antihypertensive drugs, but the 300-mg dose reduced the antihypertensive efficacy in about half the patients in both groups. In these patients, the antihypertensive effects were diminished by 63% in those with mild to moderate hypertension and by 91% in those with severe hypertension. In contrast, another study in 7 patients with hypertension taking enalapril (mean daily dose 12.9 mg) found that aspirin 81 mg or 325 mg daily for... 

CONSENSUS II 6090 patients with acute Ml Not reported Enalapril 6 months Effect of enalapril less favourable in those taking aspirin at baseline. 2... 

Meta analysis of AIRE, SAVE, SOLVD and TRACE 12763 patients with left ventricular dysfunction or heart failure with or without Ml Not reported Captopril, enalapril, ramipril, trandolapril 35 months (average) Benefits of ACE inhibitors observed even if aspirin given. 10... 

Meta analysis of CCS-1, CONSENSUS II, GISSI-3, and ISIS-4 Early treatment of Ml in 96712 patients 160 to 325 mg daily Captopril, enalapril, lisinopril 30 days ACE inhibitor reduced 30-day mortality from 15.1 to 13.8%. ACE inhibitor plus aspirin reduced 30-day mortality from 6.7 to 6.3%. II... 

Nguyen KN, Autsnes I, Kjekshus J. Interaction between enalapril and aspirin on mortality after acute myocardial infarction subgroup analysis of the Cooperative New Scandanavian Enalapril Survival Smdy II (CONSENSUS II). Am J Cardiol 1997) 79,115-19. 

Low-dose aspirin (less than or equal to 100 mg daily) does not alter the antihypertensive efficacy of captopril and enalapril. No special precautions would therefore seem to be required with ACE inhibitors and these low doses of aspirin. A high dose of aspirin (2.4 g daily) has been reported to interact in 50% of patients in a single study. Aspirin 300 mg daily has been reported to interact in about 50% of patients in another study, whereas 325 mg daily did not interact in further study. Thus, at present, it appears that if an ACE inhibitor is used with aspirin in doses higher than 300 mg daily, blood pressure should be monitored more closely, and the ACE inhibitor dosage raised if necessary. Intermittent use of aspirin should be eonsidered as a possible cause of erratic control of blood pressure in patients on ACE inhibitors. 

Nawarskas JJ, TownsendRR, CiriglianoMD, Spinier SA. Effect of aspirin on blood pressure in hypertensive patients taking enalapril or losartan. AmJHypertens(l999) 12, 784-9. 

The interaction between indometacin and ACE inhibitors is well established, with several studies showing that indometacin can reduce the blood pressure-lowering effect ofa number of ACE inhibitors. The interaction may not occur in all patients. If indometacin is required in a patient taking any ACE inhibitor, it would be prudent to monitor blood pressure. In a few small comparative studies, indometacin has been shown to have less effect on the calcium-channel blockers amlodipine, felodipine, and nifedipine, than on enalapril. See also, Calcium-channel blockers -i-Aspirin or NSAIDs , p.861. Therefore, a calcium-channel blocker may sometimes be an alternative to an ACE inhibitor in a patient requiring indometacin. 

Nitrendipine. A post-hoc analysis of the Syst-Eur trial of nitrendipine-based antihypertensive treatment found no difference in cardiovascular outcome between 861 patients who were also using long-term aspirin (700 patients) and/or other NSAIDs (161) and 2882 patients who had never taken aspirin or NSAIDs. Patients in this trial were randomised to receive nitrendipine, which could be combined or replaced by enalapril, hydrochlorothiazide, or both. ... 

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